For most people, a trip to the hospital is frightening. Even for routine treatments, hospitalizations can be confusing and anxiety inducing – an anxiety that is added to by uncertainty around fees and payments. This is because hospital pricing makes little sense, both for the patient and in general, and often leave patients with large and surprising bills.

In one of the latest examples from Kaiser Health News and NPR’s ‘Bill of the Month’ series, 44-year-old Drew Calver received a $108,951.31 bill for a heart attack. What’s most telling is that, even during his recovery from surgery, Calver was concerned about the cost. From Kaiser:

Despite the surprise, even from his hospital bed, Calver asked whether his health insurance would cover all of this, a financial worry that accompanies nearly every American hospital stay. He was concerned because St. David’s is out-of-network on his school district health plan. The hospital told him not to worry and that they would accept his insurance, Calver said.

Calver received his bill because his hospital was “out-of-network” meaning that his insurer would not cover treatment there. The problem is that Calver could hardly choose where he was going to have a heart attack, let alone known to which hospital to direct an ambulance.

The issue isn’t new and insurers have repeatedly exploited loopholes in state and federal laws to continue the practice. In this instance, Calver’s insurance did pay over $55,000 of his bill before he received his almost $109,000 bill (the original bill was for $164,941), but his bill illustrates how egregious the hospital’s billing practices are.

We’ve written on the high cost of hospital spending before, and Calver’s bill is another example of hospital billing practices that have no transparency or accountability. In fact, an article in Axios this week made this exact point, finding:

More than nine out of 10 hospitals charge at least $30,000 for joint replacement surgery — one of the most common inpatient procedures — and one out of six hospitals charges $90,000 or more…Hospitals set prices for any test or procedure at whatever level they want, often well above what Medicare pays.

As long as hospitals continue to charge whatever they want and insurers continue to saddle patients with higher costs, consumers will continue to foot the bill. Similarly, these high hospital prices drive up the shared cost of care, inflating our national health spending.

It’s why hospitals are an often overlooked driver of healthcare spending and a common burden for patients that are already trying to recover from an injury.

Until we get greater transparency and accountability from hospitals on their billing practices, consumers will continue to suffer from surprise and excessive bills. When hospitals – and insurers – are transparent, and patients can know what they will pay, true, free market forces will incentivize competition, benefiting the consumer as hospitals and payers have to work to keep their business.

For hospitals, patients know we deserve transparency, we’re just waiting for them to catch up.